Standing Committee E

[Mr. Win Griffiths in the Chair]

Health and Social Care (Community Health and Standards) Bill

Clause 167 - Replacement of the Welfare Food Schemes

Patsy Calton: I beg to move amendment No. 597, in
clause 167, page 84, line 19, leave out 
 'food of a prescribed description'
and insert 
 'milk or appropriate alternative and other foods of a beneficial nature.'.

Win Griffiths: With this it will be convenient to discuss the following amendments: No. 596, in
clause 167, page 84, line 42, after 'scheme', insert 
 'must include provision for a benefit to consist of a minimum of one pint of milk per day or the equivalent of formula milk, or the financial equivalent made available through a voucher system, or similar arrangements, and'.
 No. 600, in 
clause 167, page 85, line 10, at end insert 
 'to include the provision of 7 pints of whole or semi skimmed milk or appropriate alternative per week to beneficiaries and the provision of a third of a pint of whole or semi skimmed milk or appropriate alternative a day to children under 8 years of age in day or nursing care'.

Patsy Calton: In tabling the amendment I have more than one purpose. First, my aim is to explore the meaning of the phrase ''food of a prescribed description''. Secondly, I seek to ensure that the value of milk as a food is not downgraded, although I recognise that substitutes may well be necessary and that additional foods are, as healthy start showed, obviously desirable, if not essential.
 The historic aim behind the welfare food scheme was to provide a universal benefit that would protect expectant and nursing mothers and their children from food shortages and escalating food costs. It was an important protection for mothers and their children. Over the years, the reasoning behind the scheme has gradually been eroded. However, I should like to hear some recognition from the Minister that there is a group of mothers and children that nevertheless still requires support beyond benefits that are already available. 
 The aims behind healthy start are laudable. However, I have a difference with the Government over the means to achieve those aims. I am concerned that the values of the scheme as it is currently constituted may not be completely maintained. Amendment No. 598 would remove the proposed new section 13(4) of the Social Security Act 1988 and I will explore some aspects of that, although I shall leave 
 my comments about that until we debate that amendment. 
 The Liberal Democrats support the wish to produce a shift to breastfeeding of infants. There is no argument about that: every study by medical and health professionals has shown that breastfeeding is best for babies and their mothers, wherever it is possible. However, although the aims are, as I said, laudable, the means by which the Government intend to effect the shift to breastfeeding will be somewhat problematic. I should like the Minister to examine what the effect of removing formula milk from clinics will be, for example. I completely agree with that proposal. As a prospective mother many years ago, I was absolutely appalled at the way in which we were almost pushed down a sausage tube towards taking up formula milk instead of breastfeeding our children. I remember a film that we were shown that depicted examples of women breastfeeding in just about every place in which it would be embarrassing or difficult for some women to do so. In the end we found out that a certain formula milk distributor made that film. I was very annoyed at the time that women were, in a way, being coerced into taking up formula milk. 
 However, there will be some difficulties. I understand that the voucher will buy only a third or half a tin in a supermarket. Several groups have expressed concerns about the value of the voucher and what it will enable people to buy. The Maternity Alliance has voiced its total support for the proposal to increase the value of the vouchers for those up to the age of six months. It would be unfair if healthy start effectively cut the amount of support. That argument might also apply to babies in the six to 12-month age group. At all stages, there should be a rounding up to at least the cost of formula milk. The Royal College of Paediatrics and Child Health said that the value of the vouchers would need to be considerably higher than the value of seven pints of milk in the first year of life to allow the purchase of sufficient formula milk for those children who had never been—or were no longer—breast-fed. The Royal College of Midwives said that the Department of Health should ensure that 
''the new scheme does not create a potential risk to the health of those infants whose mothers, for whatever reasons, are unable to breast-feed.''
 The Community Practitioners' and Health Visitors' Association recommended that the minimum face value of vouchers should be the equivalent of the cost of a 900 g tin of formula milk, not 7 pints of liquid milk. All of those organisations are concerned about the value of the vouchers, and what they will buy. Liberal Democrats support that view. The hon. Member for West Chelmsford (Mr. Burns) will pick up on the point about the value of the vouchers in his contribution on amendment No. 596. 
 A major concern is that we may well encourage use of cow's milk too early, before 12 months. Access in rural areas to formula milk may well be a problem. There are better ways of encouraging breastfeeding than the methods that the Government seek to introduce. There must be support for women. I recently visited a group in the north of Manchester 
 which had carried out a pilot study in which women were encouraged before they gave birth, with support from specialist breastfeeding advisers, to breastfeed. The rates of uptake and continuance of breastfeeding was considerably higher in that group of women than the norm. That is better than effectively making it difficult for women to obtain formula milk.

Stephen Pound: Like everyone else, I have followed the hon. Lady's arguments with great interest. Is she not being overly prescriptive? Things change. When I was born, my mother was prescribed a bottle of Guinness a day, or two bottles of Mackeson milk stout. I was weaned on those substances, which may explain a great deal.
 Surely the Bill already provides the flexibility for changes in dietary and medical analysis to be incorporated, whereas the amendments that she proposes are extraordinarily prescriptive, and almost reminiscent of the Stalinist health service of the USSR.

Patsy Calton: I have the greatest respect for the prowess with which the hon. Gentleman approaches his task. However, if he reads amendment No. 597 carefully, he will see that it is rather wide-ranging. It mentions milk or an appropriate alternative, and other foods of a beneficial nature. I will return to the matter of an appropriate alternative. No one is suggesting that one should force children or their mothers to drink milk stout. I remember that I was advised to drink a pint of Guinness each night, and I wondered why I had a colicky baby for the whole of the first year. It dawned on me after I had my second child that the Guinness might be the problem. I thank the hon. Gentleman for his intervention, but I do not intend to be prescriptive.
 I am sure that the Under-Secretary will agree that it is important that mothers should receive support in breastfeeding. I am sure that she is aware of the pilot studies and will mention them later. Undoubtedly, she would want to be an adjunct to the sort of advice that was given to mothers. There are ways and means of doing that, and what I want to say on that is best dealt with under amendment No. 598. Early education has been missed out, and that is one of the problems that occurs because Departments are still acting in the sort of silos that we have complained about in local government, but which we have not yet got away from in central Government. Young people should receive education while they are still at school about their own future diets and those of infants. That would be a much better method than those about which I shall speak later. 
 There needs, also, to be a change in society's attitude to breastfeeding, not least in this place, which finds it extremely difficult to accept that women might need to work and breastfeed. This place should provide a lead in viewing breastfeeding as being a normal part of life.

Win Griffiths: Order. I have allowed the debate to be fairly wide ranging, but I do not think that arrangements for breastfeeding, in this place of work or any other, form part of the amendment.

Patsy Calton: I do, of course, apologise, and will restrict myself to the importance of milk in the diet. In tabling the amendment, my intention was to ensure that we do not lose sight of the importance of milk in the diet of expectant or nursing mothers or of their young children. Most of us are aware that milk is important for dental health. It provides a range of nutrients, especially B vitamins, and, in whole milk, vitamin A, and calcium—it is the largest source of calcium in the diet—zinc and magnesium. It is needed for bone development as well. It would be a great pity if milk were effectively lost, as it could be in the Bill as drafted.
 There is an indication that alternatives to milk, such as fizzy drinks, are linked to obesity and dental cavities. My reference in the amendment to appropriate alternatives recognises the fact that the biggest single set of allergies in young children is milk allergies. As the responses to the healthy start consultation paper show, there would be a need for soya milk and other substitutes where milk was not an appropriate food. It is not necessarily a reference to formula milk. I hope that the Under-Secretary will answer all our points and will explain how the new system can possibly meet all the aims of the Department of Health within the current budget.

Simon Burns: Mr. Griffiths, you will be aware that the clause will replace the existing welfare food schemes. I suspect that Ministers will seek to justify that by saying that they need to upgrade the schemes because the current arrangement provides low-income families with small children with a voucher that can be redeemed or exchanged for seven pints of whole or semi-skimmed milk a week, and provides for all children below five years of age at nursery school to have a third of a pint of milk per day. Few would disagree with that. I am not sure, so I shall be interested in the Minister's explanation, why the Government want to change the existing scheme. Is it simply because they believe that, because of the changes in society, the scheme is outdated, and they want to offer either milk or a piece of fruit, for example? If that is the answer, I am a little worried about it because the aim is to benefit children's nutrition and an apple has no calcium.
 I suspect that many responses to the Government's consultation process stress the importance of milk. Any changes should be based on sound evidence that they will maintain the highest standards of health for the children who benefit from the scheme. The amendment would minimise any problems that may arise in that respect by stating that the scheme must provide 
''a minimum of one pint of milk per day or the equivalent of formula milk''—
 the Minister will understand the significance of the proposal because of the difference in price, and the impact that it would have on low-income families— 
''or the financial equivalent made available through a voucher system''.
 We opted for a voucher system because if the Government were to make money available for the 
 parent to provide milk or food, sadly, in certain families that money would not be spent as the Government intended. It would be whittled away by expenditure on a variety of other, less wholesome foods for children—not even on nutritious foods for other members of the family—or possibly other things. The argument would always be that there were pressures on the family budget and that they had to use the money in a way that the Government did not intend.

Stephen McCabe: I agree with the hon. Gentleman's last remarks, but is not the problem in giving vouchers rather than money that vouchers can be traded on the black market and have additional production and administration costs? Direct provision is a more obvious solution to the problem.

Simon Burns: There are ways round the problem. A voucher could state that it could be exchanged only for goods such as milk or formula milk to minimise the possibility of abuse and prevent vouchers becoming a currency to be used for alcohol, tobacco or other household goods. I hope that the Minister will seriously consider the thoughts and the motivation behind the amendments, even if she does not accept them. Milk is probably the most important thing for young children, although I can understand her desire to encourage more members of the population to have a healthy diet and eat fruit and vegetables.
 I question whether the Government should detract from a system that has, first, worked, and, secondly, been accepted as being highly beneficial to young children for many decades. If the Minister is determined to update the system, I remind her that the nutritional value of milk and milk equivalents is superior in most cases to that of other food. The system should not be open to the sort of abuse by parents that means that children do not benefit from it, however good the Government's intentions.

Andrew Lansley: I should declare an interest in that my wife is breastfeeding at the moment—well, I do not know about this exact moment. As we know, that would be out of order, so she could not be with us today. I am not aware that we benefit from the scheme.

Simon Burns: Not on my hon. Friend's salary.

Andrew Lansley: No. One could be a beneficiary of the scheme at the time of nursery care, but that is some way off. There is a universal element to the scheme. I also declare a constituency interest, in that the Dunn human nutrition unit is in my constituency.
 I have a number of questions for the Minister. I am a little confused about the manner in which the Government have interpreted what I understood to be the original advice from the Committee on Medical Aspects of Food and Nutrition Policy's panel on child and maternal nutrition. There seems to be a discontinuity between the two things. That may be because the Government felt that, in the consultation, compelling reasons arose for why they should shift from what the scientific evidence suggested. However, I may have misunderstood what the Government 
 propose or the connection between those things, so let me run through them. 
 In some cases, I understand the nature of what is proposed and the connection. For example, the committee was clear about the fact that there is no material incentive for breastfeeding in the scheme's structure. I understand about shifting, in so far as and when it is appropriate to do so, from the provision of formula milk and milk for mothers. Milk for mothers, as I think the committee suggested, has limited value for the mother. I am referring to shifting at the appropriate point—that is probably somewhere between four and six months, but let us say for the sake of argument that it is six months—so that breastfeeding mothers have a material incentive to continue breastfeeding and there is no disincentive. I suppose the point is that there is no disincentive in the sense that they are missing out on the availability of resources to support a proper diet for their child, because they could have other, complementary foods alongside breastfeeding to the value of the voucher. I understand that, and to that extent I accept it. 
 However, the timing perplexes me, because unless I have missed something, the ''Healthy Start'' document suggests that the Government propose that, between birth and six months, there should be a shift from the provision of formula milk and milk to the mother—the current system—to a fixed face-value voucher. As far as I can see from returning to the scientific conclusions, that is not what the committee was looking for. It was looking for the provision between nought and six months of an incentive to breastfeed for breastfeeding mothers, and the continuation of the provision of formula milk for mothers who were not breastfeeding. 
 It did not seem appropriate to me to think in terms of complementary foods until the point at which one was introducing complementary foods into the diet. On that subject, the committee said that complementary foods should be introduced no later than six months of age and not before four months, which is why I referred to between four and six months. As I said, for the sake of argument let us talk about six months. I simply do not understand why the Government propose the fixed-value voucher for all mothers. Surely the design of the scheme that flowed from the recommendations from the scientific evidence would be simply to distinguish between mothers who were breastfeeding and mothers who were not breastfeeding up to the age of six months. For mothers who were breastfeeding, a voucher would be available for complementary foods to support the mother's diet at least as much as the baby's diet. Obviously, that would have some benefit after four months; they could be used in that respect. There would be the provision of infant formula for mothers who were not breastfeeding up to the age of six months. I cannot see why one would go in any other direction. 
 After six months, I am not quite sure I understand why the Government have constructed a voucher that deals with liquid cow's milk. According to the scientific evidence UK-based control trials have demonstrated that providing infant formula rather 
 than cow's milk beyond the first birthday significantly reduces the prevalence of iron deficiency anaemia. There is a reference to the desirability of infant formula for children aged up to one year. The evidence states that the current scheme allows a mother to choose between liquid cow's milk and infant formula regardless of her infant's age. Early introduction of liquid cow's milk is associated with low socio-economic status, and the scheme could be adapted to discourage this practice and thereby reduce the risk of subsequent iron and vitamin D deficiency. 
 The implication of the scientific evidence is that up to a year, in addition to infant formula, the introduction of complementary foods from some time up to four months should be encouraged through the use of the voucher alongside the incentive to breastfeeding mothers, but without the option of simply transferring to liquid cow's milk. I am not sure why the Government have gone down their chosen path. 
 The third issue is the introduction of vitamin supplements. The committee recommended that the composition of vitamin supplements should be reviewed. The evidence recommended for pregnant women: 
''A supplement providing vitamins D, C and folic acid but omitting vitamin A''.
 At a later stage, although it is not in the package of amendments to the scheme, it recommended that 
''Consideration should be given to extending the provision of free vitamin supplements to groups who are not beneficiaries of the current Scheme, particularly children from ethnic minority groups.''
 I have not seen that in the healthy start document. I would be happy to know if the Minister thinks that that has been covered. 
 The evidence also suggested that the current regime for nought to six months should be extended up to a year for low birth weight babies: 
''Low birth weight babies are at increased risk of iron deficiency. Extended provision of infant formula rather than cow's milk is therefore particularly important for this group. As infants are entitled to formula only for the first year after birth, those born very early . . . may receive liquid milk before they attain a corrected age of 1 year post term. Given that a significant proportion of children are born in the UK with low birth weight the Scheme should extend the provision of formula to those babies at the very minimum to 1 year from the expected date of confinement.''
 I want to be sure that that is the Government's intention. Although I can see a reference to infant formula for babies aged up to 12 months, if I judge correctly, for the measure to work properly, the value of the voucher would have to be sufficient to meet all the formula needs of a baby of low birth weight up to the corrected term of a year after the predicted date of delivery. That is what the scheme should provide for, which is more than the Government are proposing. 
 More questions may arise, and I may refer to them later, but the package recommended by the committee does not seem to be the package in the Government's consultation document, which is the basis for the debate on the Bill. There are gaps, and differences between the two. I am interested in finding out why 
 those gaps have emerged and whether the provisions are going to be more reflective of the scientific evidence on which the Government based their proposals.

Win Griffiths: Could I say before I call the Minister that I have been quite liberal here today? That was more of a stand part speech, but as I have two grandchildren of the qualifying ages, I thought that I would let hon. Members carry on. I warn the Committee that we shall not have a clause stand part debate. If the hon. Gentleman wants to make any further points, he should do so in brief interventions.

Hazel Blears: I am delighted that the debate is turning into a family-friendly and warm exchange of views, and I shall try to provide as much information as I can about the healthy start proposals.
 I hope that all hon. Members have seen the healthy start consultation document, which sets out the proposals for registration, the scientific basis for the scheme and how we expect the scheme to operate. I hope hon. Members have also had access to the response to the consultation document, which has been published. It contains interesting information, which has been provided by members of the public, health professionals and people who have been involved with the practical details of how the scheme might operate. I also have copies of an extract from section 13 of the Social Security Act 1988. I am told that it is occasionally the convention to provide hon. Members with previous legislation, and I have enough copies of section 13 for all hon. Members, should they be interested in seeing how the scheme operated before. I can make those available if that would be helpful. 
 The proposals to reform the welfare food scheme are based on evidence from the scientific review by COMA—the Committee on Medical Aspects of Food and Nutrition Policy—to which the hon. Member for South Cambridgeshire referred. The review assessed the scheme's effectiveness in 1999 in the first review of its kind since the scheme's inception in 1940. The scheme has been incredibly long lasting and was originally introduced in wartime, when the nation was concerned to ensure that pregnant mums and young children had access to a reasonable and healthy diet at a time of rationing and great food shortages. At that time, it was a universal benefit. Over the years, however, it has gradually come to be targeted at people on low incomes who receive social security benefits, and that is how it operates now. 
 The COMA review concluded that the current scheme, which relies entirely on milk, does not meet the wider nutritional needs of pregnant women, mothers and young children from low-income families who would benefit from a wider range of foods. The scheme currently provides just milk and formula. There is no degree of choice and no wider selection of foods. The hon. Member for South Cambridgeshire referred to the way in which the consultation document's proposals vary from COMA's recommendations. Although the proposals follow COMA's recommendations, they do not seek to 
 implement them in every respect. The COMA review provided a nutritional and scientific assessment of the scheme, from which we have taken the proposals set out in the consultation document. 
 In view of COMA's evidence, we have set out proposals to broaden the basis of the scheme by including fruit, vegetables, cereal-based foods and other foods suitable for weaning.

George Young: Reading the Social Security Act 1988 has refreshed me. The Minister was right that subsection (1) defines welfare food as liquid cow's milk and dried milk, but subsection (2) states:
''The Secretary of State may by order add any foods''.
 Why can she not use such an order to do what she is doing in the Bill?

Hazel Blears: In the Bill we are seeking to go wider than simply adding foods to the existing scheme. We raised two other important issues in the consultation document. We are not only widening the range of foods but introducing a fixed value voucher to give people an element of choice in the system. We are also linking the entitlement and the take-up of the foods and benefits to the registration process. That is an important element of the new scheme, because we are seeking to ensure that pregnant mums have access to good nutritional and health advice. Low-income families often do not have access to the same antenatal and nutritional advice as people from better-off families. Variety in the range of foods is a key element of the scheme, but the other two issues are equally important.

Simon Burns: Will the Minister say a little more about the fixed value voucher? I can understand that one could try to stop abuse by asking people to specify what the voucher had been spent on, but presumably—the Minister may correct me—it will be for X amount of money to spend on Y products. Given that the cost of the individual product will vary, how does one come up with a realistic fixed price voucher?

Hazel Blears: That is an important issue. Costs vary between rural areas to urban areas and areas where people do not have access to transport and have to use local shops, although many local shops tell me that their prices are competitive with those in other areas. The same point applies to all benefits. Benefits with a specific monetary value will buy different amounts of daily essentials, depending on where people live. Therefore, this is not a new issue for the fixed rate voucher scheme: it applies across the benefit entitlement system—and across wages, too.

Simon Burns: But surely if someone is currently receiving a quantity of milk, in a way it does not matter what the milk costs, because they are getting the milk, not X pence to buy it. If one shifts from the product to an amount, will there not be a problem because of the fixed price? If they can spend the voucher on a range of products, the different cost of each product will be a problem. What will happen in three, four or five years' time if the products have increased significantly in price? Will the Minister come back to the House and make another order to update
 the voucher? How does the voucher keep pace with inflation?

Hazel Blears: I shall try to deal with all those issues.
 The scheme is about getting the balance right between choice and prescription. At present the scheme is hugely prescriptive, as my hon. Friend the Member for Ealing, North (Mr. Pound) has highlighted, and simply applies to milk and formula. Based on scientific evidence and the consultation responses that we have received, we are genuinely attempting to introduce an element of choice. The beneficiaries of the scheme welcome the opportunity to have access to a wider range of food, including fruit, vegetables and cereals. Indeed, we expect the range of food to vary when we take into account further scientific and nutritional advice that is provided to us. The scheme has not changed for more than 60 years, but we believe that it will have to be more flexible in future. That is why we want to be able to make regulations that will provide for future variations to the scheme.

Patsy Calton: I applaud the desire to increase the flexibility of the scheme. I have no problem with that—most commentators argue that milk and fruit and vegetables are important. What concerns me and many others is that if there is a fixed amount of money to go round and bureaucratic arrangements for individual schemes are set up in different parts of the country—possibly in pilots and so on—is there not a real possibility that some mothers and children on low incomes will not benefit? The direct provision of foods may be done on an area basis, and poor mothers in areas that are generally regarded as better off may not get anything.

Hazel Blears: I am not sure what the hon. Lady's point is.
 I shall deal with the important issue of updating the scheme. We envisage that we will need a mechanism, such as increasing the value of the voucher by the rate of inflation, which allows us regularly to take into account the scientific advice that we have received when we want to add different foods to the scheme. That would ensure that the value of the voucher was maintained for families who receive it.

Patsy Calton: I am sorry if I did not explain my point well. My concern is that the Government are planning a series of schemes that add up to no more than the current provision. If the Minister can tell me that more flexibility and money will be available and that we are talking about adding on to what we have at present, I might go away satisfied. However, I am concerned that some places will just get the basic entitlement and that not everyone will be entitled to the extra.

Hazel Blears: I understand the hon. Lady's point. The scheme costs about £142 million and, as we said in the NHS plan, we want to ensure that we spend the money more effectively and on ensuring that we get more nutritional value out of it. We are not in the business of enlarging the scheme in monetary terms, but I believe that we can get better value out of the money that we spend.
 The hon. Lady's amendment would ring-fence the support for milk. I emphasise that both liquid milk and infant formula will continue to be provided as important components in the scheme. We do not intend to displace milk from the scheme or undermine its nutritional value. It is well established that milk has an excellent nutritional value for young children, but it is time to inject greater nutritional choice into the scheme and update it to ensure that it continues to meet the needs of the beneficiaries. Milk is provided in nurseries and day care, and one proposal is perhaps to provide the choice of milk and/or fruit. However, milk will continue to be an essential part of the scheme. I have met representatives of the dairy industry on several occasions and have emphasised to them how important I feel milk is to the young children's nutrition. It will be retained while we introduce the measure of choice. 
 The amendments would retain the status quo and mean that vouchers would be ring-fenced for specific volumes of milk and infant formula, which is essentially the present system. That does not allow parents to exercise the choice that we want to introduce. If we were to keep such a scheme, it would militate against the hon. Lady's aim and our move to encourage more women both to breastfeed and to breastfeed for longer.

Andrew Lansley: Is the Under-Secretary not missing the hon. Lady's point, which others are also making, that with the exception of the present allowance of infant formula above the age of six months—which was clearly excessive for the nutritional requirements of six to 12-month-olds—the present scheme broadly provides what children need? If the Under-Secretary is talking about reducing the allocation of infant formula or cow's milk for young infants or older children and directing the resources into other choices of food, the amount of infant formula or milk consumed will be less than the nutritional requirements of those children.

Hazel Blears: In reality, the hon. Gentleman and the hon. Lady are making a point about the value of the voucher and whether, if it were posited at the consultation document level of seven pints of milk, people would not be able to purchase formula and might therefore be inclined to use cow's milk instead. That would clearly be detrimental to those young children.
 However, proposals from the consultation process have been strongly in favour of having a higher value voucher for young children in the early months of their life to enable us to provide support. We will consider that in preparing the regulations, which will also be subject to consultation. Some say that more support from the £142 million total should be provided at that early stage when young children are more in need of nutritional support.

Andrew Lansley: Let me give the Under-Secretary another example. The issue is not just about the value of the voucher. It is about its structure and
 whether it is a token for a given amount of milk, plus complementary foods, which would be better. The committee said that liquid cow's milk should not be provided for infants under 12 months of age. However, the Under-Secretary is explicitly providing for a voucher that can be used to acquire cow's milk for children under 12 months of age. That does not flow from the scientific evidence. Why not stick to the nutritional requirements of children in relation to milk and provide complementary foods that would help to meet some of the other nutritional requirements?

Hazel Blears: The voucher does not specify for whom the food is to be made available, mother or child. The mother may choose to have liquid milk to augment her own diet and to exercise the voucher choice in respect of the diet of the child. The whole purpose of the healthy start scheme is to augment the diet of low-income families, which includes mothers and their children. The hon. Gentleman should take that point on board.
 The amendments tabled by the hon. Member for Cheadle would retain the status quo and would not enable us to get the incentive into the system to encourage more breastfeeding. In this country, 91 per cent. of women in social class I initiate breastfeeding and see that as the best possible start for their children. Yet just over half—54 per cent.—of women in social classes IV and V initiate breastfeeding and many of them discontinue it at an early stage. It is vital that we at least remove from the scheme the current disincentives to breastfeed.

Patsy Calton: The Under-Secretary mentions various percentages. She told us that in social class I the figure is 91 per cent. Many of us might have expected that. Can she suggest a reason why women in social class I breastfeed and others do not?

Hazel Blears: Considerable research has been carried out and one of the most compelling reasons is that women from low-income families often do not have role models. Perhaps their friends, mothers or grandmothers did not breastfeed and therefore it is not something that they think that they can do. Many do not have a support network of friends, neighbours and family members who have had experience of breastfeeding. Often women will begin to breastfeed and then get into difficulties. Unless really good health advice and support is available to them—we have talked about bringing in peer-support workers, mums who have been through the process—they are likely to give up breastfeeding. There is a whole range of factors relating broadly to the environment in which women live.
 When women have role models who are able to talk them through the process, breastfeeding rates go up enormously. I visited a sure start programme in north Kensington a few weeks ago. It had breastfeeding initiation rates of about 25 per cent. It now has a group of volunteer mums and a co-ordinator talking to and helping other mums and its breastfeeding rates have gone up from 25 per cent. to over 50 per cent.; they have doubled during the sure start programme. Those babies are getting a much better start in life and a much better nutritional foundation because the mothers have been helped to do that. 
 One of our major thrusts is to try to ensure that mums who breastfeed do not lose out, as currently they do because they do not get the same value from the scheme. Under the current scheme, mothers who choose to breastfeed receive a total of seven pints of liquid milk. Obviously, the retail value of that is substantially below that for infant formula. Infant formula is probably about £3 more expensive than the milk that such mothers currently get. A fixed voucher for all mothers would end the discrepancy and remove the disincentive. In the response to the consultation, there was strong support for putting extra resources in at an early stage of life. We will consider that as carefully as we can. 
 The hon. Member for West Chelmsford asked about having a voucher system, rather than cash. He wanted to ensure that there was no fraud in the system. I assure him that we intend to have a voucher system, together with strong counter-fraud measures because we are conscious of the need to ensure that the vouchers are not traded on the black market—as my hon. Friend the Member for Birmingham, Hall Green (Mr. McCabe) said—or used to purchase substances other than the intended kinds of food. The process will be rigorous. 
 For those reasons, I ask the Committee to reject the amendment. It would not take the scheme forward, but would entrench the status quo and militate against our proposals, which will introduce choice, widen the range of foods available to families on low incomes and enhance nutrition.

Simon Burns: I do not want to detain the Committee, except to say that I have listened to the Under-Secretary. Although I accept some of her arguments and do not want to force a vote division on the matter, I still think that amendment No. 596 would improve the situation with regard to milk and milk products. I shall therefore seek to divide the Committee on that amendment.

Patsy Calton: I had not intended to force a vote, but we must consider the point that the hon. Member for West Chelmsford has sought to establish, which is clearly in keeping with amendments Nos. 600 and 597, which try to establish that milk is important. If a vote takes place, we will support amendment No. 596.
 The Under-Secretary has addressed some of my concerns but not all of them. We will return to the issue at a later stage because the overall costs of the scheme do not add up and we do not have any actual examples of schemes to give us an idea of their intended benefits. I beg to ask leave to withdraw the amendment. 
 Amendment, by leave, withdrawn.

Stephen McCabe: I beg to move amendment No. 601, in
clause 167, page 84, line 19, at end insert— 
 '(1A) Before establishing, or varying, a scheme an order made by the Secretary of State shall be laid before Parliament to implement any Regulations under section 13(1) and shall cease to have effect unless approved by an affirmative resolution of each House of Parliament.'.
 Amendment No. 601 is tabled in my name and that of my hon. Friend the Member for Jarrow 
 (Mr. Hepburn). If it were accepted, it would achieve the opposite of my hon. Friend the Under-Secretary's intentions. Rather than giving her the flexibility and freedom to make changes as she sees fit, it would involve a cumbersome process in Parliament. 
 There has been lots of speculation about people's futures today, and I should make it clear that I do not intend to push the amendment to a vote. However, I want quickly to explain the reasons behind it, some of which were covered in our previous debates. It is no secret that several members of the Committee were approached by the dairy industry and the National Dairy Council to express their concerns. It is not necessary for me to go through the issue of milk again because we have listened to an extensive debate on the matter. It is sufficient to say that there is widespread concern that parents on low incomes should not be asked to make a choice between milk or fruit and veg for their children. The other night I spoke to someone who reminded me of the resurgence of rickets in some inner-city areas in this country, which is a persuasive argument for our continuing to have a robust welfare foods programme. 
 The purpose of the amendment is to seek assurances from the Under-Secretary that any changes contemplated in the future will be subject to a reasonable consultation process and will bear in mind people's real anxieties over that choice between fruit and veg and milk. 
 My other point concerns vouchers. I was encouraged to hear the Under-Secretary say that she will try to produce a fraud-free system. I wish her luck, but I must say that I have never quite understood the obsession that the British civil service has with vouchers. Every voucher scheme that I have ever encountered has ultimately failed, and I genuinely wonder whether this is the best way forward. 
 When I was a young trainee social worker in Edinburgh, it was possible—under the Social Work (Scotland) Act 1968—to give vouchers to families in particular need. It said in clear print on the top of the vouchers what they could and could not be traded for, but if one went into the local pub round the corner from the social work office, there was a roaring trade in the vouchers, which was nothing to do with their intended aim. 
 I remain sceptical that vouchers are necessarily the best way to guarantee the outcomes that we are seeking. All our other experiences show that they have production and administration costs and a high impact in terms of fraud through the way in which they are used. If, at the end of the day, our real object is to try to ensure the best of health—particularly for children from the most disadvantaged backgrounds—I am anxious that we should not embark on a cumbersome scheme that costs money, is open to fraud and forces parents to make basic choices between essential products that their children need. 
 I do not want to press the amendment to a vote, but I hope that my hon. Friend the Under-Secretary will recognise that there is anxiety. We do not want to move from a scheme that has worked fairly well for 60 years to one that could be subject to change on a 
 popular fashion or whim. I hope that she can assure us that any changes will be subject to reasonable consultation and will take people's anxieties into account.

Simon Burns: I strongly support the amendment, which is consistent with the approach that the official Opposition have had on numerous health Bills during the past four years. We have constantly pressed the Government that, where there are or should be regulations in a Bill to operate a crucial scheme or system, those should be subject to the affirmative resolution procedure so that the House of Commons has the opportunity to debate what the Government are doing.
 I do not need to remind the Under-Secretary—although I will briefly—that if we had had the affirmative resolution on some of the regulations for the National Care Standards Commission, or the Criminal Records Bureau checks, the Government would not have had the problems and embarrassment of the past 18 months. They have had to do a significant U-turn from their original proposals because they would not listen to the advice given to them following consultation, and get the system right. 
 I fear that, with something as significant as the changes to the welfare food scheme proposed in clause 167—and in light of the points that a number of hon. Members on both sides have made during our debates on the clause—there is the potential for considerable problems and mistakes with the fine tuning and final decisions that the Government will make on the nuts and bolts of any new scheme. 
 That is why I think it very important that when the Government come up with their final proposal, the House of Commons should have the opportunity to discuss it properly and in detail to ensure that the Government are not heading for another fall and a dreadful mistake. The only effective way in which one can do that in a Parliament where the governing party has such a large majority is through regulations with use of the affirmative procedure. That is why I congratulate the hon. Members for Birmingham, Hall Green and for Jarrow for the amendment. It is certainly not the habit of Ministers, nor of governing-party Members, to table amendments to regulations insisting that the affirmative procedure be used; 99.9 times out of 100, the negative procedure is used. I urge my hon. Friends to join the hon. Gentleman, who feels so strongly about the issue that he tabled an amendment, and to vote for the proposal to be written into the Bill.

Andrew Lansley: I share the view of my hon. Friend the Member for West Chelmsford, especially as the character of the scheme that we are discussing is not explicit in the text of the Bill. It all depends on what is in subsequent regulations. With the greatest respect to the Under-Secretary, in my doubtless inadequate fashion I raised a whole series of issues to which she gave only a limited number of responses.
 I still cannot see why the structure of the amendment would give mothers who elected to bottle feed an opportunity to divert part of the value of the voucher away from infant formula and into complementary foods in the first six months of life. It is a scientific recommendation that liquid cow's milk should not be provided for infants under 12 months of age. The Government will permit that to happen, and are not following the scientific recommendation. 
 The Committee said: 
''At 6 months of age the allowance of infant formula should halve in favour of providing tokens to purchase complementary foods.''
 As the hon. Member for Birmingham, Hall Green said when he moved the amendment, there is a difference between vouchers and tokens. The scheme is structured around tokens that are designed for specific purposes. It should, however, be designed to ensure that there is the uptake of given allowances of infant formula or milk at given ages such as six months, as the Committee recommended. 
 Clearly, there was an over-provision of infant formula. There is scope in the expenditure of the scheme to reduce that allocation of infant formula to allow complementary foods to be purchased, but that small recommendation by the Committee has been turned into a complete voucher scheme, as though that would somehow meet all the requirements. That carries a great risk that many of the nutritional benefits of the scheme will be diverted. I was, if anything, worried by the Under-Secretary's assertion that this is a supplement to the diet of low-income families as distinct from being focused on the nutritional requirements of children, which is what I understood the scheme primarily to be about.

Win Griffiths: Order. May I inquire whether the hon. Gentleman is suggesting that these ideas can be achieved only by the amendment being passed, because he has not mentioned the amendment? [Interruption.] Well, he did once.

Andrew Lansley: You are right to ask, Mr. Griffiths. I intended to say that if the amendment were not passed, my fear would be that the bulk of the provision would be achieved by negative rather than affirmative procedure. Given what I regard as the absence of answers to my questions, including the one relating to low birth weight children, to which the Under-Secretary gave no reply, we will need a debate in the House at some point to discuss the draft regulations in order to know whether Parliament approves of the scheme. It is inherently undesirable that we should be put in a position of approving legislation and then having to pray against orders to have an opportunity to assess the nature of the scheme to be proposed.

Patsy Calton: The hon. Member for South Cambridgeshire has made the points that I wanted to make. The provision is a pig in a poke; we do not know what we are getting. The schemes that the Under-Secretary will introduce at a later date may be what everyone wants, but they may not be. Coupled with our concern about whether the Budget will stretch to everything that is hoped for from healthy start, there must also be concern that the uptake will
 not be sufficient to make it work or that another flaw will not allow it to work properly for the benefit of all the mothers and children whom we hope will benefit from such schemes.
 At the moment, we do not know whether we are talking about just a voucher scheme, direct provision of foods through various outlets, community operations and so on. We simply do not know what mix of schemes might be introduced and it would be helpful if we did, so we support the amendment.

Hazel Blears: I hope that I have given some assurance to my hon. Friend the Member for Birmingham, Hall Green about the way in which the scheme will operate and the importance of milk as a component.
 I understand his concern about the effectiveness of vouchers versus cash versus direct provision. We had to consider that important issue when drafting the consultation document and thinking about the responses to consultation. My instinct is generally to incorporate such benefits into a cash entitlement. I do not particularly like vouchers because they single out people who are poor, but women in the focus groups and consultations supported vouchers. They said that vouchers ensured that they and their children actually received the benefits and the food. That is one reason why we have gone for vouchers instead of incorporating the value into the cash benefit entitlement, when it could be diverted into funding other things and not the food that is necessary for the diet of expectant mums and children.

Patsy Calton: The Under-Secretary mentioned the focus groups and I note from annexe A of the responses to the healthy start consultation that 17 special events were held in November and December. Did she mean those 17 meetings when she referred to focus groups, or were they the parents and users meetings for the sure start local programmes focus groups? Can she provide more information than I have managed to glean from the results of the consultation exercise about those focus groups?

Hazel Blears: The information came from the initial discussions with parents before we formulated our proposals. I was about to say that a decision had to be made on the balance between vouchers, cash and provision and we decided to go for vouchers. I explained why we did not go for cash and we did not go for direct provision, which is prescriptive. Directing families to go to a certain place to collect a certain food singles them out as poor and that is not what we want. In the past, people have had to go to an NHS clinic to collect their formula and we do not want to administer such a scheme. We want to introduce choice so that people can use a range of outlets—shops, food co-ops, community-based schemes and so on—to obtain access to healthy food. We believe that food co-ops and our various community initiatives are key suppliers, as is the retail sector.
 Some hon. Members asked whether there should be a choice of foods. The importance of fruit and vegetables in the diet is accepted and it is a fact that one in five children in this country does not eat any fruit at all. That should cause all of us concern; it is 
 important to introduce more fruit and vegetables into the scheme. 
 In terms of the affirmative resolution, under the Social Security Act 1988, the current scheme provides for affirmative resolution in relation to the foods. All of the other regulations are subject to negative procedure. The amendment seeks to be even more prescriptive.

Simon Burns: I am not sure how the Under-Secretary can use the words ''more prescriptive''. What is the difference between the two schemes? Life has moved on, and there is a feeling that Government should be more accountable to Parliament nowadays. We are asking that, instead of being the negative resolution—so that it slips through with minimal delay—it should be affirmative, and approved by both Houses of Parliament. How is that more prescriptive? It is a different way of giving permission.

Hazel Blears: The hon. Gentleman must accept that if we want to change the scheme regularly, as a result of the scientific advice that we receive from our advisory committee on nutrition, and to ensure that the scheme is kept up to date, the regulations need to be flexible. A scheme of this size benefits 800,000 people and costs £142 million a year. We want to make it as up-to-date and beneficial as we can. We must ensure that we are able to change the regulations, if necessary, more regularly than we can now. There will be the opportunity for hon. Members to pray against the regulations if they feel that they are not appropriate, and there will be opportunity for a proper debate. We have made a commitment to publish the initial set of regulations for consultation in early 2004, and we shall certainly consider consulting on further regulations as appropriate.
 My hon. Friend the Member for Birmingham, Hall Green makes an important point. We need maximum consensus about the way in which the scheme will operate because it concerns not just the range of foods but the registration scheme, the voucher and the value of the voucher; all important issues. We want to have maximum consultation with the public and with the health professionals involved, who have a serious job to do in providing nutritional advice to families. The arrangement will provide sufficient scrutiny of the changes at the outset and the flexibility to enable us to respond to the scientific advice that we will continue to receive, so that we can update the scheme as it develops.

Stephen McCabe: I am grateful to my hon. Friend the Under-Secretary for restating the point about the importance of milk, and for reassuring us that parents will not be faced with a difficult choice between milk and, say, fruit and vegetables. I remain a touch sceptical about vouchers, but I am prepared to accept them if they were the result of consultation with the people who are going to use them. It would be wrong of me not to respect their views. I am pleased to hear what she says about seeking maximum consensus for any changes that she makes.
 In the circumstances it seems that, despite the warm and encouraging words of the hon. Member for West Chelmsford, it would not make a lot of sense to have 
 spent the past few weeks in this Committee arguing about trying to reduce bureaucracy and to speed up processes in the health service for me to introduce a device that will be unnecessarily cumbersome.

Simon Burns: Will the hon. Gentleman explain how the affirmative resolution is more bureaucratic and cumbersome than the negative procedures?

Stephen McCabe: The point I was about to make was that the object of introducing the amendment, as I said at the outset, was to ensure that we did not have a succession of changes to the regulations without people having a proper opportunity to be consulted and to discuss them. The Under-Secretary has answered that point, so it would be superfluous for me to press the matter to a vote. Therefore, I beg to ask leave to withdraw the amendment.

Hon. Members: No.
 Question put, That the amendment be made:—
The Committee divided: Ayes 9, Noes 12.

Question accordingly negatived.

Simon Burns: I beg to move amendment No. 594, in
clause 167, page 84, line 21, leave out 'the Scottish Ministers and'.
 I shall be very brief as this is a probing amendment. In clause 167, line 21, we propose to leave out ''Scottish Ministers''. I should like to know two things. First, does the reference to Scottish Ministers mean Ministers of the national Government of the United Kingdom, or Ministers of the Scottish Parliament? Secondly, given that the Bill primarily deals with England—although there is some overlap with Wales—is it necessary to have any reference to consultation with Ministers of the Scottish Parliament on this matter? If the answer is yes, is it because the welfare food scheme is a national scheme throughout the United Kingdom?

Hazel Blears: I hope that I am able to give the hon. Gentleman the assurances that he seeks. The welfare food scheme is a reserved matter because it is based on social security benefits. The hon. Gentleman will know that most health functions are devolved. The power to prescribe a range of foods—and nutritional and health advice—has been transferred to the National Assembly for Wales. After the Bill receives Royal Assent, we intend to transfer power to Ministers of the
 Scottish Parliament, with their approval, in recognition that other health functions are devolved.
 We also intend to transfer powers to allow Scottish Ministers to direct bodies administering the scheme in relation to matters relating to the operation of the scheme in Scotland. It is important to consult Scotland and Wales on policy proposals and legislative change because their Ministers might need the flexibility in the future to adapt the scheme to meet local needs. It is a three-way process; we also wish to provide for the possibility that the National Assembly for Wales or Scottish Ministers could make a decision on matters that could affect the operation of the scheme. If they wish to make recommendations about how the scheme operates that might have implications for England, they have to consult the Secretary of State. The policy is aimed at ensuring that the scheme is, as far as possible, uniform. 
 We wish to minimise the amount of money spent on administration so that we can maximise the amount of money we spend on nutritional benefits for the families. We do not want a wide diversion of operational issues because that would lead to spending more on bureaucracy rather than delivering a better diet for pregnant women and their families, which is the intention of the scheme. 
 We have included the provision to ensure that we get the right balance between the devolved Assemblies being able to have a proper input on health, while keeping the operation of the scheme uniform, coherent and cost-effective. I hope that that has explained the situation to the hon. Gentleman, and I hope that he feels able to withdraw the amendment.

Simon Burns: Yes, it does. I beg to ask leave to withdraw the amendment.
 Amendment, by leave, withdrawn.

Patsy Calton: I beg to move amendment No. 598, in
clause 167, page 84, leave out lines 27 to 41.
 On reading the clause for the first time, I had to be held down because of my outrage at the idea in subsection (4) that a benefit, which I assume the Government think is absolutely essential for mothers and children, should be made contingent on a mother registering for a scheme and agreeing to a number of conditions. She must 
''attend a hospital, clinic or doctor's surgery''—
 not necessarily her own doctor— 
''determined in accordance with the scheme''.
 She must 
''allow herself, or a child of hers, to be examined by a doctor or nurse''.
 She must 
''allow a visit to her home by a health professional or other prescribed description of person''.
 She must also 
''receive advice of a prescribed description about nutrition, diet or other matters relating to health.''
 No one would argue that attendance at a clinic, a doctor's surgery or obtaining nutritional advice are undesirable, but to make a benefit that the state 
 considers necessary for one's health and well-being contingent on submitting to that sort of coercion seems absolutely wrong. 
 Several organisations have voiced great concern. I shall be very interested to hear what the focus groups have to say about the linking of a benefit with requirements of a sort that may be desirable, but about which people must nevertheless have a choice. Subsection (4) is a step too far, and I want it to be removed. That would not harm the clause and it would acknowledge the fundamental human rights issues that are involved. 
 A number of organisations such as the Royal College of Nursing, the Royal College of Midwives, the Royal College of General Practitioners, the Maternity Alliance and the National Childbirth Trust have made similar points about the provision. They are concerned that the onus should be on the health service to provide services that are meaningful and accessible to low-income families, and not on individual families to use health services because of ''financial coercion''. That is their phrase. 
 The Royal College of Nursing says that 
''There is no evidence cited which suggests that placing a financial incentive on low income families to use health services will improve health service uptake, or importantly, which links ante-natal or child health service uptake comprehensively and conclusively to health outcome.''
 It mentions that evidence from the United States is mixed, but adds that 
''comparing ante-natal care in France with England and Wales suggests that despite French legislation that requires pregnant women to attend for ante-natal healthcare in order to be eligible for ante-natal allowances, there is no significant difference in pregnancy outcome between the countries.''
 Those issues need to be carefully considered. The royal college says quite clearly that it believes that 
''welfare foods should remain a universal low-income benefit intended to improve the health of poorer children without additional conditions applied to their receipt.''
 and that 
''the onus should be on the health service to provide services which are meaningful and accessible to low-income families, not on individual families to use health services through any form of financial coercion.''
 There is a real concern that children 
''will not receive their entitlement based on the behaviour of their parents.''
 That must be wrong in human rights terms. I ask the Minister to address those issues. I believe that subsection (4) will be counter-productive. It may well breach human rights. Has she received advice on whether it does? 
 The measure is coercive. It requires registration and submission to medical examinations and lectures about nutrition, without which the benefits cannot be received. Astoundingly, it could damage the relationship between medical practitioners, nursing staff, midwives and the patient. Medical practitioners are worried that that crucial relationship, which should be a positive one, could be damaged, which could lead to a reduction in uptake. I asked the Minister earlier whether the calculations that have been made show that the set of schemes that she 
 intends to introduce will meet budgetary requirements. Has an assessment been made about whether the stumbling block of registration will reduce uptake of the scheme? If it does, that is absolutely wrong and the scheme must not be allowed to proceed. 
 All the educational, nutritional, medical and clinical aspects of the scheme, as well as the desired outcomes, are important, but, as the royal colleges say, the services that mothers wish to take up can be provided through education and support, instead of in this coercive and authoritarian way. I did not expect a Government in this day and age to put that kind of requirement in a Bill.

Hazel Blears: Under the reformed scheme we intend to support the healthy food benefit with the provision of information on nutrition, health and infant feeding for parents. The objective is to address health inequalities by means of preventive action and thereby to improve the scheme's effectiveness.
 As I said before, another key aim is to increase the initiation of breastfeeding. There is now extremely good evidence to suggest that low-income families have poorer access to preventive healthcare and poorer health outcomes. The Acheson report on inequalities shows that targeted intervention at this stage of families' lives can help to reduce the risk factors for the children, yet amazingly contact with the NHS is not an integral part of the present scheme: tokens are simply dispatched by the Post Office to beneficiaries if they qualify for certain income-based benefits. Important opportunities are being missed for contact between the families and the NHS that can help to improve things. 
 Under the reformed scheme, we want to try to redress the imbalance so that parents have access to information from a health professional, whether a midwife or a health visitor, and can make good, nutritional choices for themselves and their family. We know that poor diets early in life can lead to subsequent problems such as coronary heart disease, diabetes and obesity—all the problems that we as a society currently face. We believe that building robust links to the NHS by means of the proposed new registration system will be the most effective way to maximise the number of families that have access to antenatal care. The evidence is clear that parents from better-off families have significantly more access to antenatal classes, advice, encouragement and support than families on low incomes. 
 I refer the hon. Lady to page 19 of the consultation document, which I am sure she has read, which sets out how families will be able to register for healthy start. We are trying to make it as simple and the least bureaucratic we can. We do not want families to have to jump through a series of hurdles and hoops before they gain access to benefits. The patient focus groups with which we discussed those issues generally welcomed registration. They thought it would give them increased opportunities to access the nutritional information that they need to help their children. They said it was especially important for new mothers, who might lack experience and knowledge, but equally they wanted it to be simple because they would be busy 
 mums and they did not want to be bound down with lots of form filling. 
 We are therefore looking to link the scheme with existing intervention points—the early ante-natal booking or the new home birth—so that a series of new interventions is not involved. We also want to establish closer links with sure start, where every family in the sure start area is visited in the first couple of months of the child's life. As well as providing nutritional advice, there is a whole range of services now, as most of us will know from our constituency experience of the sure start programmes, which are hugely valued and welcomed by the families they support. 
 I do not accept the hon. Lady's view that encouragement and education will be sufficient to ensure that such families on low incomes, who do not currently have access to the nutritional advice that the NHS can offer, obtain the maximum benefit from the scheme. Often certain rights to benefits come with responsibilities: for example, people must be actively seeking work if they are to be entitled to jobseeker's allowance—they have to take steps to do something in return for that benefit. We are therefore not importing an entirely new principle in this respect. Of course we have to ensure that the proposed interventions are proportionate in human rights terms. The advice that I have received is that article 8 of the European convention on human rights might be engaged, and that our response would be regarded as proportionate. The evidence is overwhelming that low-income families have poorer health outcomes than families not in receipt of low incomes.

Andrew Lansley: The Minister told us earlier of the virtues of the consultation carried out, one conclusion of which reported in the regulatory impact assessment is that:
''There was strong concern that children should not be punished if mothers failed to register for the scheme''.
 I presume that the Minister has taken that on board and that a failure to register will not mean any reduction in access to benefits.

Hazel Blears: The hon. Gentleman may be aware that in the proposals as set out we indicate that there would be provision for benefits to be carried forward for several months to ensure that children would not lose access to the scheme because of non-registration. There will be a responsibility on the NHS actively to go out and encourage registration—not simply to wait for parents to come to be registered, but to seek them out. That is exactly what is happening with sure start now. The sure start maternity grant is available through a system of registration. Many families have taken advantage of that grant, for which they need to register.
 In trying to make the process simple, we are considering whether we might get self-declaration of entitlement on proof of pregnancy and on proof of having received the nutritional advice. Again, we want to make it as simple as possible for families to register. 
 We are not in the business of penalising children who already suffer tremendous health inequalities as a result of their families' lack of income. We want to do the reverse.

Patsy Calton: I want to be absolutely clear. If someone submits themselves to registration, would they then have a choice of the hospital, clinic or doctor's surgery
''determined in accordance with the scheme''
 to which they would be expected to go?

Hazel Blears: Where would be most convenient and accessible is the sort of issue that we can consider in the regulations. We certainly would not want to provide a surgery miles away from where a family lived: that would be utterly counter-productive. We want to make it as easy as we can for people to be registered under the scheme. It is not about punishing people but ensuring that as well as getting food benefits, people receive nutritional advice that will make a difference to their long-term health outcomes.

Patsy Calton: May I ask the nature of the examination that a doctor not necessarily of one's own choosing might need to carry out when one attends a hospital clinic or doctor's surgery?

Hazel Blears: Examinations may be necessary to assess children's progress. Many people have their babies weighed, and health visitors carry out a range of developmental checks on children to ensure that they are progressing properly. Those examinations are routine, as I am sure the hon. Lady knows from her own experience, and parents find them helpful in judging whether their children are making progress.

Patsy Calton: I am grateful to the Minister for her answer. However, it appears that not only will the children be examined, but that the women might also be required to submit to an examination. I well remember the types of examination, and I would much prefer those examinations to be carried out by a doctor whom I knew and trusted. In those circumstances, how can the Minister assure us that the relationship between the prospective mother and the people that she has to see will not break down?

Hazel Blears: The hon. Lady makes an important point about the relationship between doctors—and, indeed, practice nurses—and their patients. I am sure that we can take that matter into account when we consider the regulations. We would not want women to be faced with intrusive examinations by someone with whom they had no relationship. The hon. Lady's point is relevant and constructive. We want to ensure that the women concerned want to take part in the scheme. As I said, the women with whom we have discussed the scheme are looking forward to it, because they believe that it will give them enhanced benefits over those to which they currently have access.
 I have virtually finished making the points that I wished to make. I have dealt with the human rights issues—article 8 will be engaged, but the advice that we have received is that our response is proportionate. I believe that I have dealt with the points about the consultation document.

Stephen Pound: Much has been made over the past 10 minutes of the concept of ''punishment.'' Does the Minister not agree with me that there can be no greater punishment than that inflicted on a child by a parent who does not engage with the range of benefits and advice that may be available to them? Any mechanism that exists in the real, rather than the ideal, world and that cements the relationship between the parent or carer and the provider of advice or benefit should be welcomed.

Hazel Blears: I agree entirely with my hon. Friend.

Patsy Calton: Let me extend the point that the hon. Gentleman makes. If that is important for poorer mothers, it should also be important for wealthy women.

Hazel Blears: The scheme is designed to provide benefits for people on low incomes, and the registration scheme should be appropriate for them. For all the reasons that I have set out, I ask the Committee to reject the amendment.

Patsy Calton: I have listened to what the Minister had to say. I am grateful that she is as concerned as I am about the nature of the relationship between the expectant or nursing mother and children and their medical advisers, but I remain concerned that the Bill as it stands could be taken to mean that expectant or nursing mothers could be expected to go willy-nilly wherever they are sent by the scheme. I am pleased that the Minister said that that is not the intention. None the less, I would like to see something included in the Bill or in other provisions that makes it clear that relationship-building is an important part of the scheme.
 Subsection (4) is authoritarian; I would be very concerned if it were to remain in the Bill in its present form. I would like to return to it at a later stage. The Minister has indicated that she might consider some of the points that have been made. On that understanding, I beg to ask leave to withdraw the amendment. 
 Amendment, by leave, withdrawn. 
 Amendment proposed, No. 596, in 
clause 167, page 84, line 42, after 'scheme', insert 
 'must include provision for a benefit to consist of a minimum of one pint of milk per day or the equivalent of formula milk, or the financial equivalent made available through a voucher system, or similar arrangements, and'.—[Mr. Burns.]
 Question put, That the amendment be made:—
The Committee divided: Ayes 4, Noes 11.

Question accordingly negatived.

Patsy Calton: I beg to move amendment No. 599, in
clause 167, page 85, line 9, after 'vouchers', insert 
 'or, on request, a tax credit or cash benefit'.
 This is a simple point. There is a concern that an entirely voucher system might lead to the stigmatisation of some mothers. I have had discussions with a variety of people over the past few weeks about the possibility of a wholly voucher system or otherwise, and the conclusion that I have reached is that while the current method is, in a sense, a private transaction between the supplier and the person handing over the vouchers or tokens, to use vouchers of the kind that is envisaged would be difficult for at least some people. It would be better if the system could allow them to choose a tax credit or a cash benefit instead.

Chris Grayling: Is not the idea in this context of a cash payment absurd? That absolutely guarantees that some children, not all, who benefit from the scheme at present will cease to do so because their parents choose to spend the money on something else.

Patsy Calton: Thank you. I did not spend a great deal of time coming to my conclusion. I have throughout my working life heard that there are people who cannot be trusted to use what is supplied for the benefit of their children. I have a great deal more faith in poorer mothers than that. While, undoubtedly, some will not use the benefits in the way in which those of us who regard ourselves as being much wiser and more experienced would expect them to do, nevertheless I believe that parents would want to ensure that the money provided as a state benefit in recognition of their low income is spent properly.

Simon Burns: The hon. Lady says that she has no doubt that parents would want to use the money properly. Is she not aware that, for example, child benefit was paid to the mother rather than the father because under the previous system of child allowances, the father often did not pass the money on? Is she honestly saying that she believes that the money from cash payments would in even the vast majority of cases get to the children? Sadly, the reality is that all too often the money does not get to the children, because the parents are in some way dysfunctional.

Patsy Calton: I am sure that that happens in a very small proportion of cases, and mothers-to-be and parents will need support, but to claim that that will happen simply because someone is poor is wrong. I dissociate myself from the hon. Gentleman's remarks. Poor people are not necessarily feckless and will not necessarily use money incorrectly. I stand by my suggestion; on request, a tax credit or cash benefit should be payable.

Hazel Blears: In answer to a previous question from my hon. Friend the Member for Birmingham, Hall Green, I said that it was a matter of deciding which was the most appropriate way to proceed; cash benefit, tax credit or voucher. We have gone for vouchers, rather than including the provision in the cash entitlement, because parents wanted that to ensure that their children received the benefit.
 If we went down the route recommended by the hon. Member for Cheadle, we would have to administer three different schemes for vouchers, tax credits and cash distribution. We are trying to maximise the money available from the £142 million for the benefits to families and their children. Setting up three different administrative systems would eat into the amount that we have available for making a difference to the diet and health of the children in poor families. 
 I hope that the hon. Member for Cheadle will reconsider the issue and join us in trying to benefit families and their children, rather than seeking to see money eaten up in unnecessary bureaucratic schemes. I urge the Committee to reject her amendment.

Patsy Calton: I listened to the Under-Secretary carefully and was pleased that she made an economic argument rather than one about parents not choosing the correct things for their children. In those circumstances, I beg to ask leave to withdraw the amendment.
 Amendment, by leave, withdrawn.

Hazel Blears: I beg to move amendment No. 562, in
clause 167, page 86, line 34, at end insert— 
 ' ''women'' includes persons under the age of 18.'.
 The amendment is intended to ensure that all women can have equal access to the reformed welfare food scheme regardless of their age. Not all women under the age of 18 have access to the current scheme, and those who have access do so by a variety of complex and diverse means. Some of them are eligible for income support in their own right so they can be passported through, but young mums between 16 and 18 are not directly eligible for benefits and can have difficulty in getting access. 
 Some young mums' training allowances take them above the eligibility limits for income support, so they do not come through the scheme. For 16 to 17-year-old mums, access is about 40 per cent., but for 19-year-old mums, it is up to 80 per cent. We want to ensure that all women, particularly teenage mums, have access to the scheme.

Simon Burns: What happens if a young father, rather than mother, is bringing up the child?

Hazel Blears: The scheme applies to people who have parental responsibility for children.

Simon Burns: Even if they are under 18?

Hazel Blears: Indeed, as long as they have parental responsibility.
 We have not yet decided whether we would give universal entitlement to young mums under 18 or whether we would still want there to be a means-tested element. We shall examine the financial implications, because we might be able to help all young mums within the financial parameters of the scheme; I am interested in exploring that option. At the moment some younger women have to get access through their parents' entitlement to benefit. That is not the right way to administer the scheme for those young mums. 
 We want the flexibility to introduce another system, so I commend the amendment.

Andrew Lansley: I support the amendment, but the Under-Secretary will recall from the scientific committee's evidence that the younger the pregnant woman, the greater her nutritional requirements yet the lower her intake is likely to be, so extending the scheme to teenage pregnant mothers is desirable. She will not be surprised if I come back to some specific questions. She knows that I am still interested in vitamin supplements and how they are to be provided, since healthy start does not say that they will be made available to pregnant women.
 Although we have talked about the incentives for breastfeeding, I am still not clear on one or two other points. Why do the Government persist, in the face of the scientific evidence, in offering an alternative to breastfeeding or infant formula for infants under the age of six months? Why are the Government providing an option under the scheme to move away from breastfeeding or formula before the age of 12 months? Finally, have the Government accepted the recommendation that low birth weight babies—this is particularly relevant to teenage mothers—be entitled to receive formula until at least one year from the expected date of delivery, not the date of birth?

Hazel Blears: I am happy to respond to the hon. Gentleman on the points that he made earlier. We want to examine how we can provide longer access to formula for low birth weight babies, perhaps in the regulations, in order to make up the difference. I am told that that could be administratively difficult, but the scientific committee has nevertheless raised that important issue and I would certainly want us to explore how we can provide the right support for those infants.
 I thought that I had already responded fairly robustly to the hon. Gentleman's point about moving away from COMA's recommendations on infant formula and/or breastfeeding. The fixed-value voucher does not specify for whom the food is to be made available, because we want to ensure that there is choice in the system. Those mums who are breastfeeding may choose to spend their voucher on other items of healthy food, such as fruit, vegetables, cereals and so on, whereas those mums who are not breastfeeding will spend their vouchers on the formula to be available to them. 
 The important point is the value of the voucher in that early period. In the response to the consultation—I tried to make this point to the hon. Gentleman earlier—there was a great deal of support for the idea of perhaps making available a voucher of a higher value during that early period of life than during later periods. We are going to consider that issue, so that we can provide enough monetary value to enable that access. However, the hon. Gentleman seeks to limit the scheme and to dictate to those families exactly what they should have at which period of the child's development. We have genuinely tried to get the balance right between ensuring that there is access to that extra support and introducing an element of choice so that we do not dictate to those families what they can have at exactly what point. That is an 
 important principle. I accept the fact that the hon. Gentleman does not agree and thinks that we should have a more prescriptive scheme, but I cannot agree with him on that. 
 Amendment agreed to. 
 Clause 167, as amended, ordered to stand part of the Bill.

Clause 168 - Appointments to certain health and

Patsy Calton: I beg to move amendment No. 370, in
clause 168, page 86, line 44, at end insert— 
 '(1A) This section applies to the CHAI and CSCI.'.
 My hon. Friend the Member for Sutton and Cheam (Mr. Burstow) was supposed to be here to move the amendment, but the Committee will have noticed that he has much to do. The amendment is probably self-explanatory. The clause is headed 
''Appointments to certain health and social care bodies'',
 and subsection (1) states: 
''This section applies to a body (however established) which has functions relating to—
(a) health;
(b) social care;
(c) the regulation of professions associated with health or social care.''
 We simply seek to establish that the clause also applies CHAI and CSCI.

Hazel Blears: Amendment No. 370 seeks to ensure that the clause covers CHAI and CSCI. The clause provides for the Secretary of State to delegate to a special health authority his function of making appointments to certain health and social care bodies. It is clear that CHAI has functions relating to health care and that CSCI has functions relating to social care. By definition, therefore, they are already covered by the clause. A previous debate about the independence of CHAI and CSCI went on for some time, and the hon. Member for Sutton and Cheam acknowledged then that the policy intention was for the Secretary of State to delegate his appointments functions in relation to CHAI and CSCI to the NHS Appointments Commission. I can restate that intention today, but we should not reopen that debate on the basis of the amendment, which I ask the Committee to reject.

Patsy Calton: I am grateful to the Under-Secretary for that explanation. I beg to ask leave to withdraw the amendment.
 Amendment, by leave, withdrawn.

Hazel Blears: I beg to move amendment No. 547, in
clause 168, page 87, line 23, at end insert 
 'and includes any function relating to the appointment to or removal from (whether permanently or otherwise) any particular office in the membership of the body.'.
 The amendment is designed to allow for the delegation to the NHS Appointments Commission of the power to appoint or remove people from specific posts. It is intended to clarify that the commission will 
 have the power to deal with people who hold offices as well as being members of the various organisations. 
 This is very much a technical amendment, which is judged necessary to clarify that decisions can be made in relation to such posts. It will ensure, for example, that the commission can appoint or remove chairs or vice-chairs in the way that the Secretary of State would have been able to do had he not delegated his authority to the commission. I therefore ask the Committee to support the amendment. 
 Amendment agreed to. 
 Clause 168, as amended, ordered to stand part of the Bill.

Schedule 11 - Privy Council appointments

Hazel Blears: I beg to move amendment No. 548, in
schedule 11, page 128, line 14, after 'exercise', insert 
 'to the extent specified in the direction'.

Win Griffiths: With this it will be convenient to discuss the following:
 Government amendments Nos. 549 to 558.

Hazel Blears: This group of amendments serves to clarify a couple of points about schedule 11, which deals with the way in which lay members are appointed to regulatory bodies for health professionals, such as the Nursing and Midwifery Council and the General Medical Council. At present, the Privy Council appoints such members but, in practice, that is generally done on the advice of Health Ministers.
 We are keen to strengthen the regulation of the professions and to make them more clearly independent of Government, and schedule 11 does that by letting the Privy Council delegate appointments. We have it in mind that such decisions will be delegated to the NHS Appointments Commission, and the amendments make it clear that the Privy Council could delegate the whole appointments process—that is what we think is most likely—or specify which parts of the process are to be delegated to the commission. For example, the Privy Council might want the Appointments Commission to conduct the interviews and to make the recommendations, and it might want to hang on to the right to make the final choices. 
 One final detail is that amendments Nos. 553 and 554 make it clear that the Privy Council may delegate its function of appointing the chairman of the General Optical Council from among the members that it appoints. The General Optical Council is the only regulator whose chairman or president is appointed by the Privy Council; the others elect their own chairmen from among their members. The amendments are sensible and contribute to a more transparent way of appointing lay members. The lay members will be seen to be impartial and at arm's length from the Government. I commend the amendment to the Committee.

Andrew Lansley: I shall not delay the Committee. I apologise to the Under-Secretary; if I had thought about it, I would have notified her in advance that I was going to ask her a particular question. I shall ask the question, but I do not expect a reply on this occasion. It would be fine if she were to respond to the Committee later.
 When the Health Professions Council was being introduced, the Under-Secretary may recall that one issue about which I corresponded with the Department was the separate recognition of the Society of Clinical Perfusion Scientists of Great Britain and Ireland and its representation on the Health Professions Council, which remains unresolved. 
 The Under-Secretary says that the Privy Council can delegate the appointments process to the Appointments Commission. I am worried that that will mean that I have less access to Ministers to seek their agreement that we might pursue further the question of the separate recognition of the Society of Clinical Perfusion Scientists of Great Britain and Ireland as a health profession. I am asking her not to discuss the merits of that subject, but to indicate that we can discuss it separately. I hope that Ministers are not omitted from the process because that would raise work force management issues for the health service. I hope that we can continue to make representations and to discuss such matters.

Hazel Blears: My instinct is that recognition is a separate matter from the delegation of the appointments process. I am happy to enter into further discussion and correspondence with the hon. Gentleman to seek clarity on that matter.
 Amendment agreed to. 
 Amendments made: No. 549, in 
schedule 11, page 128, line 26, after 'exercise', insert 
 'to the extent specified in the direction'.
 No. 550, in 
schedule 11, page 128, line 29, after 'force', insert 
 'and for the purposes (if any) specified in the direction'.
 No. 551, in 
schedule 11, page 129, line 2, after 'exercise', insert 
 'to the extent specified in the direction'.
 No. 552, in 
schedule 11, page 129, line 25, after 'exercise', insert 
 'to the extent specified in the direction'.
 No. 553, in 
schedule 11, page 129, line 39, leave out 'its functions' and insert 
 'to the extent specified in the direction— 
 (a) its functions'.
 No. 554, in 
schedule 11, page 129, line 40, at end insert— 
 '(b) its functions under paragraph 8 in relation to the nomination of the Chairman of the Council.'.
 No. 555, in 
schedule 11, page 130, line 8, after 'exercise', insert 
 'to the extent specified in the direction'.
 No. 556, in 
schedule 11, page 130, line 21, after 'exercise', insert 
 'to the extent specified in the direction'.
 No. 557, in 
schedule 11, page 130, line 35, after 'exercise', insert 
 'to the extent specified in the direction'.
 No. 558, in 
schedule 11, page 131, line 9, after 'exercise', insert 
 'to the extent specified in the direction'.—[Ms Blears.]
 Schedule 11, as amended, agreed to. 
 Clause 169 ordered to stand part of the Bill.

Clause 170 - Validity of clearance for employment

Hazel Blears: I beg to move amendment No. 559, in
clause 170, page 88, line 12, after second 'body', insert 
 'or an employment agency or employment business'.

Win Griffiths: With this it will be convenient to discuss the following:
 Government amendment No. 560.

Hazel Blears: The amendment provides for equal treatment for organisations working within the NHS to provide temporary staff for the health service and commercial employment agencies, which also supply temporary staff to the NHS. The amendment will remove the practice of carrying out annual checks on temporary staff already employed in the NHS who have been previously checked against the Protection of Children Act 1999 list and, when it is introduced, the list on the protection of vulnerable adults. That will ensure that there is no discrimination against the commercial sector in favour of NHS professionals. We want a level playing field and the further easing of the requirements will be beneficial while retaining the essential protection for children and vulnerable adults. I commend the amendment to the Committee.
 Amendment agreed to. 
 Amendment made: No. 560, in 
clause 170, page 88, line 37, after second 'body', insert 
 'or an employment agency or employment business'.—[Ms Blears.]
 Clause 170, as amended, ordered to stand part of the Bill. 
 Clause 171 ordered to stand part of the Bill. 
 Further consideration adjourned—[Jim Fitzpatrick.] 
 Adjourned accordingly at twenty-six minutes to Five o'clock till Tuesday 17 June at five minutes to Nine o'clock.